Myeloma Service, Department of Medicine, Memorial Sloan-Kettering Cancer Centre, 408 East 69th Street, Z-719, New York, NY, 10021, USA.
Best Pract Res Clin Haematol. 2020 Mar;33(1):101151. doi: 10.1016/j.beha.2020.101151. Epub 2020 Jan 23.
Over the course of the past decade-plus, the therapy of newly diagnosed multiple myeloma has seen incredible advances in the domains of diagnostic evaluation, active medical therapy, and response evaluation. This manuscript reviews the evaluation and management of newly diagnosed active multiple myeloma, with a focus on major clinical trials and IMWG recommendations. The paper describes a current approach for the initial evaluation and workup for patients with putative active myeloma, with consideration towards potential MRD-directed therapeutic approaches and future clinical trials, and then discusses management with a focus on induction regimens with attention primarily to modern three and four-drug combinations for transplant-eligible and transplant-ineligible patients, and those with organ dysfunction. Finally, this article briefly reviews minimal residual disease directed therapy approaches, primarily in the context of whether eligible patients should be referred for high dose chemotherapy and autologous stem cell rescue. Maintenance therapy for both transplant eligible and ineligible patients is discussed elsewhere in this issue.
在过去十余年中，新诊断多发性骨髓瘤的治疗在诊断评估、积极的医学治疗和反应评估领域取得了令人难以置信的进展。本文回顾了新诊断活动性多发性骨髓瘤的评估和管理，重点关注主要临床试验和 IMWG 建议。本文描述了目前针对疑似活动性骨髓瘤患者的初始评估和检查方法，考虑了潜在的基于微小残留病灶（MRD）的治疗方法和未来的临床试验，然后讨论了治疗方法，重点是诱导方案，主要关注适用于有移植资格和无移植资格的患者以及有器官功能障碍的患者的现代三联和四联药物组合。最后，本文简要回顾了基于微小残留病灶的治疗方法，主要是在有资格的患者是否应接受高剂量化疗和自体干细胞挽救的背景下进行讨论。本专题的其他部分讨论了适合移植和不适合移植患者的维持治疗。
